Provider Demographics
NPI:1407976137
Name:TUTTLE, NANCY ATWELL (ANP-BC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ATWELL
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PLAGEMAN BLDG
Mailing Address - Street 2:OREGON STATE UNIVERSITY
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97331-8567
Mailing Address - Country:US
Mailing Address - Phone:541-737-9355
Mailing Address - Fax:
Practice Address - Street 1:201 PLAGEMAN BLDG
Practice Address - Street 2:OREGON STATE UNIVERSITY
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-8567
Practice Address - Country:US
Practice Address - Phone:541-737-9355
Practice Address - Fax:541-737-9665
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08466063363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500682285Medicaid